Guest guest Posted March 9, 2007 Report Share Posted March 9, 2007 I have a 22 year old pregnant woman with severe hyperemesis that has already resulted in hospitalization and intravenous fluid administration at by 9 weeks. She has tried all the oral prescription meds without success. Intravenous administration of fluids and meds, and a feeding tube three days ago brought her weight up to 122 (was 144 pre pregnancy at 5' 6 " ) but she has been unable to ingest food or water to any significant extent afterwards. She dislikes ginger. Yin and blood deficient, with stagnation. Tongue is still rehydrated from the IV but shows heat in the liver and gallbladder and purple sublingual veins. This is her second pregnancy and her first, 2 1/2 years ago, had less severe hyperemesis starting at 2 1/2 months and lasting until 5 months but in that case she was able to find 4 hours or so in the evening when she could eat. Menstrual periods have been problematic with a severe rash around her neck and upper chest, dizziness, vomiting and extreme fatigue. She has a family history of hyperemesis, but not as severe as her own. Also has a history of palpitations and digestive upsets requiring her to take 5 or 6 small meals a day. Food content when she isn't throwing up is generally high quality omnivorous, broken by occasional binges of sugar or salty food. Lactose intolerant and she did not find a gluten free diet prevented the emesis. Has headaches she attributes to allergies but which sound migraine-like, with occasional auras and piercing pain behind the eye or eyes. Even more of a miner's canary than most pregnant women: hypersensitive to light, odors, excessive environmental activity and tastes. She has associated gingerale and saltines with vomiting by now and dislikes them, also had a bad reaction to ginger tea. Fennel seeds and licorice trigger emesis from smell alone. The problem is certainly exacerbated by a childhood history of sexual abuse (ages 3-12) and unstable childhood. Her first pregnancy was the result of rape, although she chose not to abort because she believes life experiences have a purpose. Her current pregnancy is the result of a loving relationship but happened at an inconvenient time and she has just relocated north. Any thoughts on suitable herbs or nourishment? I gave her acupuncture, some grounding visualization to do and suggested she experiment with sushi ginger which I find better tolerated by many. Sent her home with magnets on P6. She could only take Flintstone's chewable vitamins, at triple dose, during her last pregnancy since she vomited up the prenatal vitamins. I suspect that any herbs will similarly need to be given in a sweetened or lightly chewable form as she progresses. I am at somewhat of a loss as to how to build up her yin and blood, given restriction on points and an easily triggered vomiting reaction. Karen Vaughan, MSTOM Licensed Acupuncturist, and Herbalist 253 Garfield Place Brooklyn, NY 11215 (718) 622-6755 http://www.byregion.net/profiles/ksvaughan2.html <BR><BR><BR>**************************************<BR> AOL now offers free email to everyone. Find out more about what's free from AOL at http://www.aol.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2007 Report Share Posted March 10, 2007 Hi Karen, Challenging case study, difficult to give herbs because patient throws up alot. What do you think about patent pills, they might be easier to keep down. Obstetrics & Gynecology in (Maciocia) lists in Ch 29 the main principles in treating morning sickiness: always pacify the penetrating vessel, subdue rebellious Qi, harmonize the Stomach and stop vomiting. In addition treat any other patern present (pacify liver, eliminate stagnation, tonify stomach & spleen, clear ST Heat or resolve Phlegm). He lists six seven patterns [w/ herbal patent remedies are listed for each pattern] :1) ST Qi xu w/ xu cold [Li Zhong Wan}, 2) ST Yin xu [Jade Spring (a Three Treasures remedy)], 3) Stagnant LV Qi invading ST [soothe the Centre (a Three Treasures remedy)], 4) ST Heat, 5) Phlegm accumulation, 6) HT Qi xu [Gui Pi Wan] and 7) HT Fire. What is your pattern differentiation? If patient has a history of miscarriage Tu si zi, du zhong and sang ji sheng could be useful. Also, the text mentions that she should try to eat little and often and she should avoid greasy & fatty foods, and that mint is often helpful. I hope this is of help, Steve creationsgarden1 wrote: I have a 22 year old pregnant woman with severe hyperemesis that has already resulted in hospitalization and intravenous fluid administration at by 9 weeks. She has tried all the oral prescription meds without success. Intravenous administration of fluids and meds, and a feeding tube three days ago brought her weight up to 122 (was 144 pre pregnancy at 5' 6 " ) but she has been unable to ingest food or water to any significant extent afterwards. She dislikes ginger. Yin and blood deficient, with stagnation. Tongue is still rehydrated from the IV but shows heat in the liver and gallbladder and purple sublingual veins. This is her second pregnancy and her first, 2 1/2 years ago, had less severe hyperemesis starting at 2 1/2 months and lasting until 5 months but in that case she was able to find 4 hours or so in the evening when she could eat. Menstrual periods have been problematic with a severe rash around her neck and upper chest, dizziness, vomiting and extreme fatigue. She has a family history of hyperemesis, but not as severe as her own. Also has a history of palpitations and digestive upsets requiring her to take 5 or 6 small meals a day. Food content when she isn't throwing up is generally high quality omnivorous, broken by occasional binges of sugar or salty food. Lactose intolerant and she did not find a gluten free diet prevented the emesis. Has headaches she attributes to allergies but which sound migraine-like, with occasional auras and piercing pain behind the eye or eyes. Even more of a miner's canary than most pregnant women: hypersensitive to light, odors, excessive environmental activity and tastes. She has associated gingerale and saltines with vomiting by now and dislikes them, also had a bad reaction to ginger tea. Fennel seeds and licorice trigger emesis from smell alone. The problem is certainly exacerbated by a childhood history of sexual abuse (ages 3-12) and unstable childhood. Her first pregnancy was the result of rape, although she chose not to abort because she believes life experiences have a purpose. Her current pregnancy is the result of a loving relationship but happened at an inconvenient time and she has just relocated north. Any thoughts on suitable herbs or nourishment? I gave her acupuncture, some grounding visualization to do and suggested she experiment with sushi ginger which I find better tolerated by many. Sent her home with magnets on P6. She could only take Flintstone's chewable vitamins, at triple dose, during her last pregnancy since she vomited up the prenatal vitamins. I suspect that any herbs will similarly need to be given in a sweetened or lightly chewable form as she progresses. I am at somewhat of a loss as to how to build up her yin and blood, given restriction on points and an easily triggered vomiting reaction. Karen Vaughan, MSTOM Licensed Acupuncturist, and Herbalist 253 Garfield Place Brooklyn, NY 11215 (718) 622-6755 http://www.byregion.net/profiles/ksvaughan2.html <BR><BR><BR>**************************************<BR> AOL now offers free email to everyone. Find out more about what's free from AOL at http://www.aol.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2007 Report Share Posted March 10, 2007 Hi Karen, One of my teachers, Dr. Qiu Xiao-mei had some insights that may help in this case: First, Yin vacuity of the Kidney and Stomach cause the worst kind of hyperemesis. Ginger would be patently contraindicated. Ginger only works if there is Qi or Yang Xu or dampness with a pale tongue. Dr. Qiu created her own formula, based on Fu Qing-zhu's San Qing Yin for Yin Xu threatened miscarriage that she also uses for hyperemesis in pregnancy. It is called Jia Wei San Qing Yin - The three green drink Sang Ye Follium Mori 30 gm. Zhu Ru Caulis Bamusae in Taeniis 12 gm Si Gua Luo Tan Carbonized Luffae Fasciculus Vascularis 6 gm Shu Di Huang Prepared Radix Rehmannia 30 gm Shan Yao Rhizoma Dioscarea 15 gm Du Zhong Cortex Euannia 15 gm TuSiZi Semen Cuscutae 9 gm Dang Gui Shen Corpus Radicis Angelicae 6 gm BaiShao Sinensis Radix Peoniea Alba 15 gm You can give it as an enema if she cannot take it orally. Also she could take it in sips throughout the day or in capsules. Good luck Sharon On Mar 10, 2007, at 11:21 AM, wrote: have a 22 year old pregnant woman with severe hyperemesis that has already resulted in hospitalization and intravenous fluid administration at by 9 weeks. She has tried all the oral prescription meds without success. Intravenous administration of fluids and meds, and a feeding tube three days ago brought her weight up to 122 (was 144 pre pregnancy at 5' 6 " ) but she has been unable to ingest food or water to any significant extent afterwards. She dislikes ginger. Yin and blood deficient, with stagnation. Tongue is still rehydrated from the IV but shows heat in the liver and gallbladder and purple sublingual veins. This is her second pregnancy and her first, 2 1/2 years ago, had less severe hyperemesis starting at 2 1/2 months and lasting until 5 months but in that case she was able to find 4 hours or so in the evening when she could eat. Menstrual periods have been problematic with a severe rash around her neck and upper chest, dizziness, vomiting and extreme fatigue. She has a family history of hyperemesis, but not as severe as her own. Also has a history of palpitations and digestive upsets requiring her to take 5 or 6 small meals a day. Food content when she isn't throwing up is generally high quality omnivorous, broken by occasional binges of sugar or salty food. Lactose intolerant and she did not find a gluten free diet prevented the emesis. Has headaches she attributes to allergies but which sound migraine-like, with occasional auras and piercing pain behind the eye or eyes. Even more of a miner's canary than most pregnant women: hypersensitive to light, odors, excessive environmental activity and tastes. She has associated gingerale and saltines with vomiting by now and dislikes them, also had a bad reaction to ginger tea. Fennel seeds and licorice trigger emesis from smell alone. The problem is certainly exacerbated by a childhood history of sexual abuse (ages 3-12) and unstable childhood. Her first pregnancy was the result of rape, although she chose not to abort because she believes life experiences have a purpose. Her current pregnancy is the result of a loving relationship but happened at an inconvenient time and she has just relocated north. Any thoughts on suitable herbs or nourishment? I gave her acupuncture, some grounding visualization to do and suggested she experiment with sushi ginger which I find better tolerated by many. Sent her home with magnets on P6. She could only take Flintstone's chewable vitamins, at triple dose, during her last pregnancy since she vomited up the prenatal vitamins. I suspect that any herbs will similarly need to be given in a sweetened or lightly chewable form as she progresses. I am at somewhat of a loss as to how to build up her yin and blood, given restriction on points and an easily triggered vomiting reaction. Karen Vaughan, MSTOM Sharon Weizenbaum 86 Henry Street Amherst, MA 01002 413-549-4021 sweiz www.whitepinehealingarts.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2007 Report Share Posted March 10, 2007 , Steve Sterling <acusteve1 wrote: > > Hi Karen, > Challenging case study, difficult to give herbs because patient throws up alot. What do you think about patent pills, they might be easier to keep down. ... What is your pattern differentiation? Thanks Steve, She has had trouble taking vitamins so I don't know that the patents will be any easier. My diagnosis is yin and blood deficiency with stagnation and rebellious qi due to liver invading stomach. I gave her P6, four gates, ear shenmen and sympathetic, and take home magnets on P6. As she becomes less fearful I may be able to do more. Quote Link to comment Share on other sites More sharing options...
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